Provider Demographics
NPI:1659593721
Name:LEUNG, LARRY PUILAM (OPHTHALMIC DISPENSER)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:PUILAM
Last Name:LEUNG
Suffix:
Gender:M
Credentials:OPHTHALMIC DISPENSER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135-37,
Mailing Address - Street 2:37 AVENUE
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354
Mailing Address - Country:US
Mailing Address - Phone:718-888-9679
Mailing Address - Fax:718-888-9672
Practice Address - Street 1:13537 37TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354
Practice Address - Country:US
Practice Address - Phone:718-888-9679
Practice Address - Fax:718-888-9672
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2018-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156FX1800X
NY6791156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician